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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used primarily in patients with end-stage renal disease (ESRD). It is more effective than calcium carbonate at lower doses due to higher calcium solubility across a wider pH range. 667 mg of calcium acetate contains 169 mg of elemental calcium.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initial Dose:** 667 mg orally with each meal.
* **Titration:** Adjust based on serum phosphate levels. Most patients require 1,334 mg (2 tablets) per meal.
* **Maximum:** Generally limited by serum calcium levels; doses exceeding 3 doses per meal (>2,000 mg/meal) are rarely used due to hypercalcemia risk.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established in pediatric patients.
* **Dosing:** Use is off-label and requires nephrology consultation. Dosing is typically individualized based on serum phosphate and dietary intake, often starting at lower concentrations similar to adult titration models.
## Dose Adjustments
* **Hypercalcemia:** If corrected serum calcium exceeds 10.5 mg/dL, the dose must be reduced or temporarily discontinued.
* **Renal Impairment:** Intended for use in ESRD. No renal dose adjustment required beyond titration to targets.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, and abdominal pain.
* **Serious:** Metastatic soft tissue calcification (if hypercalcemia and high calcium-phosphate product occur).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Administer antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Reduces absorption. Separate administration by at least 4 hours.
* **Bisphosphonates:** Reduces absorption. Maintain a 2-hour gap between doses.
## Monitoring
* **Serum Phosphorus:** Monitor at least monthly during titration. Goal: per KDIGO guidelines (usually 3.5–5.5 mg/dL).
* **Serum Calcium:** Monitor weekly during initiation and dose titration; monitor monthly thereafter.
* **Calcium-Phosphorus Product:** Avoid exceeding 55 mg²/dL² to prevent metastatic calcification.
## Clinical Pearls
* **Administration:** Must be taken with meals to effectively bind dietary phosphorus.
* **Hypercalcemia Risk:** Monitor for signs including weakness, lethargy, confusion, and cardiac arrhythmias.
* **Calcium Intake:** Avoid concomitant use of other calcium-containing supplements or vitamin D to prevent hypercalcemia unless specifically directed by a nephrologist.
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*Disclaimer: This information is for educational purposes only. Always verify dosages and clinical protocols against the current institutional formulary, prescribing information, and patient-specific medical history before administration.*
